INDIAN INSTITUTE OF BANKING & FINANCE ‘An 0 900%: 2008 Organisation THEASCAO XPPLIGATION FORM FOR CERTIFICATE EXAMINATION IN ANTLMONEY LAUNDERING AND KNOW YOUR CUSTOMER EXAMINATION APPLIED FOR; JUNE [—] DEC: L—_] cekinannonate ton MEMBERSHIP NUMBER NAME (Capital Letters) (MrJMs.) ADDRESS FOR ‘COMMUNICATION (Please inform change of adress, Hany In ftur, tothe Instute) PIN CODE, (Compulsory) DATE OF BIRTH MOBILE | TEL.NO.wtn 81D cose) (Compulsory) FAX NO, (with STD Code) E-MAIL QUALIFICATION (Computsor CENTRE CODE CENTRE NAME: (Press reer nsttion No. 8) NB. Only ontne Examination wil be conducted. In case ofa carte where there ae les tan 10.candates,Insttite wl allat he nearest conte, EXAMINATION / REGISTRATION FEE : Refer instruction No. 3 PAYMENT DETAILS: For payment by DEMAND DRAFTIPAY ORDER: DD NUMBER DO DATE "AMOUNT ‘DRAWEE BANK & BRANCH For payment by GASH AT AXIS BRANCHES (please enclose part of challan for IBF containing receipt stamp of AXIS Bank) SUP NOWEER DATE: “AMOUNT BRANCH ADDRESS Fox paymorntby GASHAT SBI BRANCHES (please enclose par of challan for IBF containing receipt stamp of SBI Bank) SUP NUMBER DATE AMOUNT ‘BRANCH ADDRESS DECLARATION Examination Apptemon Form once suited cannot be be refine! adjunod Lam 2 member of indian Insts of Banking & Frcs dclre ha ave nt bow torn appeag lhe iatues rari na ne of aching ths spp far farenain eas of depute heey ap ceargs shal bested any Cours athena, Kolkata Now Oa &Marba abs case ay berinwhosouiedicion Saleaionietubmisegoyme andnatnary oer Incase of online examination | understand that: 2) Though insttate will be aking al necessary precautions to conduct the examination smoothly itis possible that some candidates may not be ableto appearicomplteins examination normally on account of technical auministratvefalire of he Computer System b) the techncalladmnstatvefallire could be rected within manageable time (maximum 30 minutes), then candidates willbe requested to re-slarthe examination onthe same day inte same test centre, by serving the same questo paper wih balance ime lef or wih afferon {question paper with full uration 0) ine tennealadninatatve problem cant bo actos wthin manageable mo(naxinum 30 mutes). en posal the anda wilbsanadiotherearytext cont ad they wild srvedtha same qvston pape withoalnce tne or wih afore question paper ‘ith tauaton 4) Tfeplons mentoned at) and c) are not possible, then re-examination willbe conducted separately fr such candidates ona suitable future dato ortho alfeciodsubjocl. PLAGE: DATE SIGNATURE OF THE APPLICANT youre PARTICULARS FOR ISSUING MEMBERSHIP CARD / EXAMINATION IDENTITY CARD (To be filled in by those who have not received the Membership/Non-member Examination Identity Card) EXAMINATION APPLIED FOR: ANTIMONEY LAUNDERING MEMBERSHIP NO./REGISTRATION NO. AND KNOW YOUR CUSTOMER (cas otron-nenbes, Rep No 198 les nby se) NAME (Capital Letters) NAME OF THE EMPLOYER'S (sopicanle) ‘SPECIMEN SIGNATURE {lobe signed in tree boxes) PHOTOGRAPH OF APPLICANT one owe eae beat se ie ae NOTE (for members): To receive Member's Identity Card, Membership Subscription should not be in arrears.INDIAN INSTITUTE OF BANKING & FINANCE ‘An ISO 8001: 2008 Orgarisation| “THE ARCADE, WORLD TRADE CENTRE, EAST WING, CUFFE PARADE, MUMBAI - 400 00. CERTIFICATE EXAMINATION IN ANTLMONEY LAUNDERING AND KNOW YOUR CUSTOMER IMPORTANT INSTRUCTIONS TO THE CANDIDATES. ‘Application Form ance submits cannot be withdrawn and fes wil ot be refundediagusted, Eligibility governed by rues published nthe Rules and Syabvs Booklet For mombers wile applying Examination, Membershi Subseriplan shoulsnolbe in arears ‘Application form should reach the Insttute’s Zonal fee on or before the last date of receipt of Examination Application Form mentioned in the timetable of te Examination. Appiation Form received after ths date willbe rated for next examination. Applicaton Forms found electivelincompletewilbe ejected EXAMINATION FEES REGISTRATION FEES: a) Forkembers | _ForNonMembers Festattompt™ Rs. 2000/- @Rs. 30000. ‘Subsequent each ater Rs. 500% Re. 1000 “Includes e-learning and frstattempt examination fee @ Includes registration fe of. 500 ') Members may optany ofthe fllowing modes fo submission of application and making payment of Tees. 1) Payment by cash in any of the AXIS or SBI Branctes, using the payment chalan, memloning the Membership Number and Examination fr which applied. Payment challan can be printed from our web ste www.ibforain under Courses/EXaminatons and also avalable on request al the Zonal Offices Each payment challan downloadedioblaied rom the Zonal Ofices can only be used by ‘single candidate or singlepaymentas each challan shaving unique pay-r-slip Number Photocopies are not val Payment by Demang Draft/ Payorder in favour of INDIAN INSTITUTE OF BANKING & FINANCE. and made payabie at Mumbal CChennal Koleaa or New Delhi (depending upon the Zonal fea to which he member belongs), Members are alo equestedto wrt thal mambership number & name on backside of the Demand Drat/ Payorder For online submission af application form and payment through our web-site ww ib. org.in. please folow the instructions therein for the purpose. ‘STUDY MATERIAL: Examination fee does not include cos of study material Please visit wwwibf.org.into know further details 2 a EXAMINATION CENTRE: (Refer CentroList) (0) Candidates are requested to submittheir application forms along with payment to the respective Zonal Office to which they belong. The dress of Zonal Ofices areas flows 4. Eastern Zonal office Indian Institute of Banking & Finance, 408,"Anandlok’, Block 4th Floer,227 Acharya, Bose Road, Kolata-700020. Telephone: 033-22800581/82/83 Fax: 022-22809600 E-mail: ibee@ib.or in 2. Norther Zonal Office: Indian Institute of Banking & Finance, 109-113, Vkrant Towers, 1st Floor 4, RajendraPlace, New Delhi-110 008, Telophane:0%1-25752191/92 Fax. 011-25752186 E-maitibn zi orn 3, Southern Zonal Office: Indian institute of Banking & Finance, No.94, Jawaharlal Neild, (109 Fest Road) Opp. To HotelAmbica Empire, Vadapalan,Chenna-600028.. Telephone: 044-2472289024727981 Fax: 044-24726986 E-malibsz@ibLorg in 4, Western Zona Office: Indian Institute of Banking & Finance, 191-F Makor Towers, 1th Floor, Cuffe Parade, Mumba-400 005 Telephone: 022-22183302/22185134 Fax: 022-22180845 E-nalt\bw2@ibforain (i) Candidates should appear forthe examination only atte centre where they are working provided thee isan examination centre at such place and ithereisno examination centre, they should appear al henearost examination centr. (ii) The Verueorthe examination willbe advised while issuing te examination AdmitLetor, (iv) Requestor change in centre due to transfer or anyother valid raason should reach the Institute 45 days before the commencement of ‘thoexamination Any requostrecoWved thereafter wilnotbe entertained, () No change of cantra request wil be accepted fr personal reasons. ithe and deputaton etc. should be accompaniedby employer's authentication, ‘The Institute reserves the right to close any of the existing centrels on account of less number of candidates appearing from ‘such ease, candidate will be advised to appear atthe examination from squests in case of change of contre due to transfer, raining [MODE OF EXAMINATION: Examination willbe conducted underanine mode only, Candidates are requested to read the Instructions / infomation about ONLINE / OFFAINE examination before appearing for the examinations. The instructions are available. on’ the homepage of Insltute's wobsita.wwwilbtorgin’ under the” tink INSTRUCTIONS INFORMATION ABOUT ON-LINEIOFF-LINE EXAMINATIONS OF THE INSTITUTE ADMIT LETTER: (i) The Instiute's Corporate Ofce wil issue Examination Admit Letters’ conaining details of verue and tie ofthe examination as wel as seria: password tobe used nile appearing at fe examination User willbe the Memberssip Number ot he candidate (i) Permanent Membership identity Car i issued by the respective Zonal Office atthe time of adnvssion as a member or renewal of ‘membership oron receipt of Examination Application Farm whicheveris eae. (ii) The examination AdmitLetter alongwith the Membership Ident Card shouldbe produced the Examination Authoiy each time inthe examination venue foridentieaton (i) In absence of Examination Admit Letter Membership Kently Card, the candidate is lable tobe denied permission in the examination (©) Admit Letor will be available on our wobsite wirwib.ora.in one weok before the dato of examination. Candidates who do not facolvethe admitlatierby post may download l fromthe website.